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Sign-off by ‘other methodologies’ (OM)

Throughout the curriculum, several competencies are marked for potential sign-off using ‘other methodologies’ (OM). The College introduced this to facilitate learning and potentially facilitate sign-off for certain conditions that aren’t commonly encountered in clinical practice. This page sets out how OM sign-off should be used.

It’s paramount that your trainers encourage you, and that you as a trainee try, to access hands-on clinical exposure wherever possible to facilitate learning, experience and sign-off. OM is meant to be a back-up to situations where clinical exposure hasn’t occurred, which is possible given the rarity of some conditions; OM isn’t meant to replace clinical exposure.

If you go on to gain clinical experience beyond the OM sign-off, you should have the curriculum item previously signed via OM countersigned by the trainer involved. A further CbD, reflection or mini-CEX could be done as evidence. Thus, sign-off can be achieved by OM alone, but can still be enhanced by further clinical exposure if it happens.

The ePortfolio details where you are most likely to need to use OM to facilitate sign-off. However, occasionally there may be other specific and individual circumstances where OM could be used. The decision to use OM lies with your Educational Supervisor, who will confirm with you if OM sign-off is appropriate to use and will document the specific reason(s). Remember that OM is meant to be a back-up for use when clinical exposure to a rare or unusual condition hasn’t occurred. It isn’t meant to replace clinical exposure in all circumstances.

Guidance on the use of OM

Case-based discussions (CBD)

CbD could be done with an individual trainee or a small group of 3–4 trainees; any more than this and there’s a risk that not all trainees will have the opportunity to interact sufficiently to demonstrate knowledge and understanding. Trainees can be at different stages and should each be assessed according to the level of their training.

The trainer should identfy a curriculum item, such as uncomplicated uterine rupture, and set a case or scenario. This may be real, perhaps a case that has occurred recently in the unit from which the group could all learn. It may be also be set by the trainer drawing on past experience. The following ATSMs include suggested CbDs:

  • Advanced labour ward practice
  • Labour ward lead
  • Advanced laparoscopic surgery for the excision of benign disease
  • Colposcopy

The trainer facilitates a discussion on presentation, management, complications (expected and unexpected) and outcomes, pushing the trainee(s) on salient points, such as when to call for help from a colleague or an allied specialty. If the trainer is satisfied that the trainee has exhibited appropriate knowledge and interacted in the discussion, and can summarise ‘how to manage [topic]’, the trainer signs off the curriculum item, clearly marking that this has been signed off via OM, as well as allowing the opportunity for a CbD to be completed for those involved.

Departmental/deanery teaching

A trainee could volunteer or be asked to prepare a presentation/teaching session on a curriculum item amenable to OM. For example, a group of trainees could get together to cover maternal medicine, where some of the rarer conditions (e.g. peripartum cardiomyopathy and microprolactioma) are marked OM. They could present this as a small group session to a group of trainees with a supervising consultant.

If the supervising consultant is satisfied that the trainee(s) has/have demonstrated an appropriate level of knowledge on the subject, they could sign off the competency via OM. The trainees would file the presentation or teaching materials in the personal library of their ePortfolio as evidence.

As well as allowing an opportunity to demonstrate evidence of small group teaching, the trainee could seek feedback on their presentation to fulfill elements of core curriculum module 2: teaching, appraisal and assessment.

Guideline discussion

Within a department, possibly as part of a journal club or audit meeting, a trainee could lead a discussion on the department’s compliance with best practice guidelines, for example the RCOG’s Green-top Guideline on cervical cerclage. The discussion would demonstrate understanding of the curriculum item marked OM, in this case insertion of cervical cerclage. It could also be used as evidence of presentation skills and critical appraisal skills, therefore also fulfilling these curriculum items.

Preparing a root cause analysis

A trainee could find an opportunity to carry out a department root cause analysis or serious incident report for a competency marked OM, such as maternal collapse or complicated uterine rupture. This would provide evidence of understanding of management of such an event and allow sign-off by OM, and would also fulfil an element of core curriculum module 3: risk management.

Preparing a guideline

A trainee could be involved in, or lead on, the preparation or revision of a departmental guideline on one of the curriculum items marked OM, such as cord prolapse. This would demonstrate their knowledge of the condition and the appropriate management, allowing sign-off by their trainer. It would also allow the trainee to fulfil  the ‘prepare or revise a guideline or care pathway’ element of core curriculum module 3: clinical governance.

Practical skills and procedure courses

Trainees will attend a range of courses throughout their training. Some of these courses, e.g. MOET, provide trainees with an opportunity to demonstrate their ability to manage situations such as obstetric collapse. A third- and fourth-degree perineal repair course which includes practice on simulated or animal tissues could provide the evidence by OM of repair of a fourth-degree tear. The evidence that a trainee has attended such a course, with a certificate in their ePortfolio, and a discussion with their trainer could facilitate sign-off of this item.

StratOG (eLearning)

StratOG is the RCOG’s online learning resource, and is free to access for all Fellows, Members and registered Trainees. There are 114 core tutorials covering the breath of the curriculum. For the rare conditions such as choriocarcinoma or those only seen in specialist clinics such as psychosexual problems, there are modules including assessment and case histories. Trainees could complete such a module in their account and this could be demonstrated in their learning history. If the trainee completes a reflective entry on their learning from the module which satisfies the trainer and is countersigned, this would allow the trainee to be signed off via OM for that curriculum item.

Using the operating theatre

Trainees and trainers could use innovative teaching opportunities, such as the demonstration of the technique to perform a myomectomy on a benign total abdominal hysterectomy specimen that’s been removed. A CbD could be completed following an operative case, for example of uncomplicated caesarean section, detailing all the possible postoperative complications, including intrabdominal bleeding such as broad ligament haematoma. If the trainer pushes the trainee on all the salient points and is satisfied that the trainee could manage this complication should it arise, they could sign off the curriculum item by OM and complete a CbD as well as an OSATS for the procedure

RCOG membership exams

MRCOG exams

Information on how to prepare for the Part 1 and Part 2 MRCOG